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Annualreport Health Action in Crises Health Action in Crises Primary Health Care in Crises annualreport 2008 © World Health Organization, 2009 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Acknowledgments The HAC Annual Report 2008 was produced under the overall coordination of Giuseppe Annunziata (editor-in-chief). Contributors (in the order in which the section appears in the document): Giuseppe Annunziata (Quantifying crises); Camille Pillon assisted by the Regional Offices (2008: continuing challenges); Xavier de Radiguès, Claudine Prudhon, Pierre Salignon (Improving mortality and nutrition data collection and analysis in crises); Erin Kenney (Using the cluster approach at country level to improve humanitarian health action); Michelle Gayer (Communicable disease control in humanitarian emergencies); Paul Garwood, Camille Pillon (Communicating health action in crises); Rudi Coninx (Staff competency: a critical element); Jon Carver, Liudmila Cheremukhina, Jules Pieters, Olex Babanin (Getting operational); Nicole Adler, Jukka Sailas (Funding for WHO’s emergency work). The Primary health care in crises section was produced by Giuseppe Annunziata and benefited greatly from the inputs and com- ments of the following people: Jonathan Abrahams, Samir Ben Yahmed, Olga Bornemitza, Rayana Bouhaka, David Bradt, Francesco Checchi, Cristina Del Pueyo, Xavier de Radiguès, Cintia Diaz-Herrera, Richard Garfield, André Griekspoor, Omar Khatib, Daniel Lopez Acuña, Dudley McArdle, Abdelhay Mechbal, Roderico Ofrin, Heather Papowitz, Enrico Pavignani, Jonny Polonsky, Claudine Prudhon, Kumanan Rasanathan, Lynda Redwood Campbell, Chen Reis, Gerald Rockenschaub, Pierre Salignon, Luzitu Mbiyavanga Simao, Wim Van Lerberghe, Dana Van Alphen, Mark Van Ommeren, Nevio Zagaria, Ahmed Zouiten. The report was edited by Paula Soper, assisted by Camille Pillon and Connie Calvert. Design and layout: Steven Ewart Graphs: Camille Pillon, Samuel Petragallo Photographs: WHO/Marko Kokic (Cover and title page); IRIN/Siegfried Modola (p. iv); WHO/Madeleine Decker (p. 2); WHO/Paul Garwood (p. 7); IRIN/Allan Gichigi (p. 8); WHO/EURO (p. 9); Yu Yanyan (p. 12); WHO (p. 13); WHO/Ibrahima Fofana (p. 14); WHO/SEARO/Anubhar Das (p. 15); WHO/Michel Tomaszek (p. 16); WHO/Chris Black (p. 19); UNMIS/Tim McKulka (p. 20); WHO/Myanmar (p. 22). Health Action in Crises Foreword 1 Quantifying crises 3 Natural disasters 4 Armed conflicts 5 Severe food insecurities 5 Population movements 5 A methodological challenge 6 2008: continuing challenges 7 January–December 8–18 Crisis issues 19 Improving mortality and nutrition data collection and analysis in crises 20 Using the cluster approach at country level to improve humanitarian health action 21 Communicable disease control in humanitarian emergencies 22 Communicating health action in crises 23 Staff competency: a critical element 23 Getting operational 24 Funding for WHO’s emergency work 25 Primary health care in crises 27 Voices from the field 28 PHC renewal: responding to the challenges of a changing world 29 Humanitarian crises: a continuous threat 29 Humanitarian health action as part of the PHC renewal: common principles and synergies 30 PHC renewal and humanitarian action: moving towards a rights-based approach 40 Concluding statement 40 Way ahead 41 End notes and references 42 iii Health Action in Crises Ethiopia iv annualreport 2008 Foreword WHO’s emergency work is often associated with flying in tons of humanitarian sup- plies and medicines to aid the survivors of high-profile disasters, dispatching emer- gency health experts to help save lives, and working with ministries of health to stave off public health threats during humanitarian crises. While all this is true, it represents only the most visible part of our work. Through- out the year, WHO staff also work behind the scenes to help governments prepare for emergencies and put in place the kinds of resilient, sustainable, community-oriented health care services that can cater for all segments of the population before, during and after crises. No one agency can address all the complex challenges posed by humanitarian crises. Humanitarian health action must be planned and implemented in close collaboration with partners in order to coordinate efforts, avoid duplication and fill gaps. In 2008, WHO, as lead agency of the Health Cluster, focused much of its efforts on introducing the cluster approach in several new countries. This has resulted in better coordination, enhanced health care delivery and greater joint efforts in many settings. WHO will continue to pursue the cluster objectives of coordinated action, strengthened account- ability and greater predictability by expanding the cluster approach to new countries in 2009, in close collaboration with national authorities and local communities. Humanitarian health action must be implemented in the field, where crises occur. WHO strengthened its emergency operational capacity in 2008 by expanding its hu- manitarian supply network and further developing its emergency standard operating procedures. These efforts have paid off: WHO was one of the few humanitarian agen- cies with an international presence in Myanmar and in Gaza during the acute phase of the emergency. WHO is also strengthening and consolidating its overall logistics capacity. Health Action in Crises is working with other technical areas to pool operational resources and know-how into a common operational platform to support the Organization’s re- sponse to various types of emergencies, from communicable disease outbreaks to natu- ral disasters, from chemical incidents to complex crises. Contributions for WHO’s emergency work rose to their highest-ever levels in 2008, reflecting donors’ increased trust in WHO. Equally, implementation kept pace with donations, indicating WHO’s improved capacity to utilize emergency funds. Primary health care (PHC) is the issue on which WHO has been providing global stewardship for decades. WHO has continued to be a strong advocate of the PHC ap- proach, and has devoted its 2008 World Health Report to this important topic. Taking its inspiration from the 2008 World Health Report, the last part of the present report attempts to place PHC in a humanitarian context. People are at the core of the PHC approach just as they are at the centre of humanitarian health action. From Gaza to Goma, WHO has been helping health providers strengthen and consolidate the PHC approach in order to ensure that millions of people, particularly those in vulnerable settings, are able to cope and remain healthy when faced with crises. Eric Laroche Assistant Director-General Health Action in Crises 1 Health Action in Crises Burundi 2 annualreport 2008 Quantifying crises The need for systematic data collection about the magnitude and analysis of trends of natural and man-made disasters is an increasing concern of both development and humanitarian response agencies. However, data on disasters, their effect upon people and their cost to countries are currently not collected in a systematic and standardized fashion.1 The recently-established Health and Nutrition Tracking Service will attempt to redress this situation by supporting quality measurement of key health indicators using appropriate, standardized measurement methods. In the meantime, and bearing in mind the above limitations, some current data on various humanitarian crises are presented in the following section. 3 Health Action in Crises Natural disasters According to the Center for Research on Epidemiology of Disasters (CRED), the number of natural disasters in 2008 was 321 – below the annual average of 398 for 2000–2007.2 However, according to the same source, 2008 saw a marked increase in the number of deaths compared to the 2000–2007 yearly average. CRED calculates that natural di- sasters killed 235 816 people in 2008. This death toll – more than three times the annual average of 66 812 for 2000–2007 – was mainly caused by two
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